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Abstract：
Diabetic kidney disease (DKD) is a common complication of diabetes mellitus and approximately 1/3 of diabetic patients may progress to DKD. A typical early clinical manifestation of DKD is microalbuminuria and patients may present with macroproteinuria accompanied by a decrease in renal function condition as the disease progresses. It is generally believed that the likelihood of a reversal of the disease is reduced after the development of macroproteinuria in patients with DKD, and that eventually some patients\' condition may develop into end-stage renal disease (ESRD). Moreover, the thickening of the glomerular basement membrane, mesangial matrix expansion, Kimmelstiel-Wilson (K-W) nodules, and glomerulosclerosis in end-stage diabetes mellitus are typical pathologic changes of DKD. However, some DKD patients, especially those with type 2 diabetes mellitus (T2DM) combined with DKD, may have diverse clinical manifestations, showing variations in disease progression and regression, and manifesting as non-classical types of DKD, such as normoalbuminuric DKD, proteinuria-reduced DKD, and DKD with rapid decline in renal function. In addition, the formation of crescents, a special pathological change, is observed in renal biopsy. However, this issue is currently under-recognized by clinicians and therefore deserves more attention. In order to improve clinicians\' understanding of the presentations and pathological changes of non-classical DKD and the level of DKD prevention and treatment in China, we present a preliminary introduction to the clinical phenotypes and pathological changes of non-classical types of DKD in this paper by summarizing the findings of our prior studies as well as domestic and international literature.
摘要：
糖尿病肾病（DKD）是糖尿病的常见并发症，约1/3的糖尿病患者可能进展为DKD。DKD的典型早期临床表现是微量白蛋白尿，随着疾病的发展，患者可能会出现大量蛋白尿并伴有肾功能下降。一般认为DKD患者出现大蛋白尿后,病情逆转的可能性降低,最终，某些患者的病情可能发展为终末期肾病（ESRD）。此外，肾小球基底膜增厚,系膜矩阵展开，Kimmelstiel-Wilson(K-W)结节,终末期糖尿病的肾小球硬化是DKD的典型病理变化。然而,一些DKD患者,尤其是2型糖尿病（T2DM）合并DKD，可能有不同的临床表现，显示疾病进展和消退的变化，表现为非经典类型的DKD，比如正常白蛋白尿DKD，蛋白尿减少DKD，和DKD，肾功能迅速下降。此外,新月的形成，一种特殊的病理变化，在肾活检中观察到。然而,这个问题目前临床医生认识不足,因此值得更多关注.为了提高临床医师对非经典DKD的表现和病理变化的认识以及我国DKD防治水平,本文通过总结以往的研究结果以及国内外文献，对非经典型DKD的临床表型和病理变化进行了初步介绍。
